Brain MRI Findings in Severe COVID-19: A Retrospective Observational Study

Area of Science:

• Neurology
• Radiology
• Infectious Diseases

Background:

• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is linked to brain MRI parenchymal signal abnormalities.
• Understanding neuroimaging in severe coronavirus disease 2019 (COVID-19) is crucial for patient management.

Purpose of the Study:

• To detail the brain MRI findings, excluding ischemic infarcts, in hospitalized patients with severe COVID-19.
• To correlate neuroimaging patterns with clinical severity and outcomes.

Main Methods:

• Retrospective analysis of brain MRIs from 37 patients with severe COVID-19 and neurological manifestations.
• Inclusion criteria: positive SARS-CoV-2 test, severe disease, neurological symptoms, and abnormal brain MRI.
• Exclusion criteria: ischemic infarcts, cerebral venous thrombosis, or unrelated chronic lesions.

Main Results:

• The most common neurological symptoms were altered consciousness (73%), confusion (32%), and agitation (19%).
• Frequent MRI findings included medial temporal lobe abnormalities (43%), white matter lesions with enhancement (30%), and microhemorrhages (24%).
• Intracerebral hemorrhage (54%) was associated with more severe illness, higher ICU admission rates, and acute respiratory distress syndrome.

Conclusions:

• Severe COVID-19 patients without ischemic infarcts exhibit diverse neurological symptoms and associated abnormal brain MRI findings.
• Eight distinct neuroradiologic patterns were identified, highlighting the spectrum of brain involvement in severe COVID-19.
• Brain MRI findings, particularly hemorrhages, are linked to poorer clinical outcomes.